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HomeMy WebLinkAboutVerity, Kira ,,iii.__._ ,.',,o�os�FFQ(�. 0" G % ELIZABETH A. NEVILLE �t��a� tk : Town Hall, 53095 Main Road TOWN CLERK ; y Z , P.O. Box 1179 •REGISTRAR OF VITAL STATISTICS , 'illSouthold, New York 11971 MARRIAGE OFFICER :` �1 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ‘41#*- Ol jig *.,,'�� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �40' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2435 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : KIRA VERITY Address 1 : 30485 MAIN ROAD City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-00-0223 Name Of Owner VERITY, KIRA Mailing Address 1 30485 MAIN ROAD City St Zip CUTCHOGUE NY 11935 Property Address 1 4004 OLD NORTH ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 55.00 block 2 lot 5.001 Cross Street MT. BEHLAH AVENUE Building Permit Number Cross Reference: Issue Date: 10/18/00 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 0° 4%SUfFO�,� 7 35 ELI (k) i � ����� oo ELIZABETH .NEVILLE � < Town Hall, 53095 Main Road TOWN CLERK y P.O. Box 1179 REGISTRAR OF VITAL STATISTICS_._ ; �t� Southold, New York 11971 MARRi*OE OFF10ER : y s. Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �4l ����11� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER i�� Sit OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: October 17, 2000 Transmitted herewith is a copy of application No. 2523 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Kira Verity Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. /Signa Dated OFi•'IC'E OF THE TOWN CLERK s,. COOcti/� TOWN OF SOUTHOLD ��6• !'`p/. Application No.2 ELIZABETH A.NEVILLE,TOWN CLERK • O' �/ ` P.O.BOX 1179 ; Construction SOUTHOLD,NEW YORK 11971 p T t Alteration Telephone 44 4V.0: $10.00 - Residential (516) 765-1801 --�1 4 ,,," $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. + Fee $ �\-l�'S�P� DATE � , �-X k.G-) D) C.) APPLICANT NAME: APPLICANT ADDRESS: ()t),; IDI-W) MCS.).c��( 0-.Q\ SEPTIC 7C. CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION C Q>--)'- ' ' 'S\" . \v C) " Q\V\ Mc LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: \ c \:: Q$ OWNER MAILING ADDRESS: °DDD- c-j n.c)_, n z,c-KA • -f 0‘. sD OWNER PROPERTY ADDRESSLIco _, b0. S• a\. 1 A f_ t \c1 () I TELEPHONE NUMBER OF CONTACT PERSON : (c, \- 5(c,`- -- - 2g TAX MAP NO. : Section Block g- Lot 5 . CROSS STREET: \ , c5\kQN __ 3Q \ BUILDING PERMIT NUMBER CROSS REFERENCE: -1'-•----\'‘ igna of Applica t l RECEIVED BY : To n Jerk's Office DATE: ��l/ CS 1 • i 1 •/ .. ._ 1 • i am INHi 1M. . 4..r - FOR APPROVAL ! • NV GSM TJbNf ," 4,y "ACE SEWAGE m ' SYSt�EYS !r'Alw,Y REQS u s r 6 > TEST HOLE e l 24 I Lail& file coiq lb/o forth filerob find on fire > a /8 & ora brown own* to coed. y W w awe a. r, 2 O_ J • t Brow l lawny Tb. /ocesons of w. aid cesspools 0£0 o q Darer day 3' shown Wenn are from Send ob irroHons Np 1, = F u P sc m s h Brondi m� or from data obtained*from others. R y Rp40 . o o c t... .- 4 - 17.4- 2 E0 0, LA- 1 o a 4( u. }..cn�: 4 J e 4. in V F1 Q ¢\J p U.i'dT a� !J As 0 d' U. 7 ),- wohr a+biose .H-I- WO, : apyo WARD as 4kil0 o - �to, .14. 2 = o cc y I LOT 0 '. p12 '` W ' 0 4....1 k 11 SA Q e ` Q e: Seras2, S 85:30"50-E. 0.J N te g - to o ` e coarsWater k e u1 sp.ks _ 2t.' N fsand - V N ' » 2.93.27' to , ? .a , sw 42. a O h.h / Sy3I1'.' 9 . 1 ii we// V ``� •4i LOT l .© l� ® o,� ai SURVEY & ,5d.,, k 'o � ,o CI - .o L2 h TOPOGRAPHICAL SURVEY o 0 0,1, fy OF PROPERTY o � n, c S... _. AT SOUTHOLD �,,� - �. TOWN OF SOUTHOLD ' --------� e•3 �',� d SUFFOLK COUNTY, N. Y. 4 ; ase ?2•G . Neo. , ,k p, i 3 4 1000-55-02-5.f el rt' ' o-w vs , WIN_ o > Scale: Y"- 40' at,-.0. . . Jan. 29 1999 w NZ SEPT. 13, 2000 Hest hole 1 0 'WO/ T.►t a .J sept. 201 web(revision) `y p96.9T ,i ` • ^,o cn -ry AREA 40,000 El ft ,iY E 1'3.3 '`Q��Otrri .ME►�QNo i ro�� ryir N m � y ANY Argun ton , ,..7@ ISMVEY-ISA VIOLATION • Nu��s?1' �+ ns a. CI C II TTO.r o " - dT TE t AtT.o r LLAAtt ,� * -4Q, p ,i 171 tea. C ON ARE VALID �• » ,MAP` :g7EIEAE V LY F17GNts i �oP /tv All a r ':a a C f . ,. �„N .S. LICt '0. 964, SAD bMr OR cones SEAL Of-THE 6LRYEl'QR ELEVATJONS'AND CONTOUR LANES ARE REFERENCED �.ry - �,�, Maw SIINATte� t' TO AN ASSUMED PATL$4. 1 1-1: . �f�! ,_.,y <n Y Tb cp�Y, .LAW 7I TERM'ALTERED or* 71 . .s. T, P.c. tulip�Y ANCIr . vWet' ICED LOT NUMBERS ARE REFERENCED TO ApVOR SUBDIVISION P `:•' -• 1 631 1 765- 1797 or sx19��Yp � ....„...4..... PREPARED FOR NTO W. AKAA�AM FILED NV THE OFFICE 7?€LAW OF THE SOUTHOLD TOWNCLERK 1230 STREET SOUTHOLD, N.Y. 1197/ 9R- .?Rn